1. A 40-year old female presented with a proliferative mass in the right parotid gland and duct. Surgical excision was performed and histopathological examination revealed the presence of Rhinosporidium seeberi, confirming a rare case of rhinosporidiosis involving the parotid duct.
2. Rhinosporidiosis is a benign fungal infection caused by Rhinosporidium seeberi, most commonly involving the nose and nasopharynx. Primary involvement of the parotid duct is extremely rare.
3. Diagnosis is made through histopathological identification of the characteristic sporangia of R. seeberi. Treatment involves surgical resection as recurrence
• Actinomyces species are classified as anaerobic, gram positive and filamentous bacteria.
• It is a chronic granulomatous suppurative and fibrosing disease caused by anaerobic or microaerophilic gram-positive nonacid fast, branched filamentous bacteria.
• Most of the species isolated from actinomycotic lesions have been identified as A. israelii, A. viscosus, A. odontolyticus, A.naeslundii or A. meyeri.
• These microorganisms have been identified in dental plaque, dental calculus, necrotic pulp, and tonsils.
• The usual pattern of this disease is one characterized chiefly by the formation of abscesses that tend to drain by the formation of sinus tracts.
• pus from the abscesses is examined on a clean glass slide, it shows the typical ‘sulfur granules’ or colonies of organisms, which appear in the suppurative material as tiny, yellow grains.
• Another infection that produces this type of sulfur granules is botryomycosis.
occulomycosis- infections of eye and its related structures by various fungal agents.
3 broad category
1.keratomycosis
2.fungal endophthalmitis
3.fungal infections of occular adnexa
paracoccidiodiomycosis- its a acute subacute chronic ,systemic fungal infection
mainly effect respiratory system from there disseminated to various body parts.
Mycology is a small topic in microbiology where questions appears less in pg entrance but still we need to know it and learn about it in safe side... so here is a ppt with detailed explanation and images
Ocular virology; an Introduction
Lecture delivered by Dr. Iddi Ndyabawe (MMed Ophthalmology, 1st year at Makerere University, Uganda). Modulator: Dr. Lusobya Rebecca (Ophthalmologist)
• Actinomyces species are classified as anaerobic, gram positive and filamentous bacteria.
• It is a chronic granulomatous suppurative and fibrosing disease caused by anaerobic or microaerophilic gram-positive nonacid fast, branched filamentous bacteria.
• Most of the species isolated from actinomycotic lesions have been identified as A. israelii, A. viscosus, A. odontolyticus, A.naeslundii or A. meyeri.
• These microorganisms have been identified in dental plaque, dental calculus, necrotic pulp, and tonsils.
• The usual pattern of this disease is one characterized chiefly by the formation of abscesses that tend to drain by the formation of sinus tracts.
• pus from the abscesses is examined on a clean glass slide, it shows the typical ‘sulfur granules’ or colonies of organisms, which appear in the suppurative material as tiny, yellow grains.
• Another infection that produces this type of sulfur granules is botryomycosis.
occulomycosis- infections of eye and its related structures by various fungal agents.
3 broad category
1.keratomycosis
2.fungal endophthalmitis
3.fungal infections of occular adnexa
paracoccidiodiomycosis- its a acute subacute chronic ,systemic fungal infection
mainly effect respiratory system from there disseminated to various body parts.
Mycology is a small topic in microbiology where questions appears less in pg entrance but still we need to know it and learn about it in safe side... so here is a ppt with detailed explanation and images
Ocular virology; an Introduction
Lecture delivered by Dr. Iddi Ndyabawe (MMed Ophthalmology, 1st year at Makerere University, Uganda). Modulator: Dr. Lusobya Rebecca (Ophthalmologist)
There are some guide questions that students can focus on this chapter. Also, helps the teacher to organize better and have a well explained chapter lesson.
La somministrazione di lavoro è stata recentemente oggetto di importanti modifiche da parte del D.Lgs. n. 81/2015 che ne ha esteso l’ambito di applicabilità.
Glosarium card.teks biografi , a,moersyid dan a nuralif x tkr 1 vocsten malangNuril anwar
Glosarium card.teks biografi , a,moersyid dan a nuralif x tkr 1 vocsten malang adalah hasil karya siswa dalam KBM Bahasa Indonesia dalam membangun konsep tuk memahami teks biografi deng browsing untuk mengamati menginterpretasi, mendiskusikan serta menyimpulkan dengan harapan dapat menulis teks biografi denga struktur, poenggunaan bahasa secara benar. keslahan itu pasti karena itu mohon kritik dan saran demi perbaikan
—Fungal organisms are ubiquitous. A common location for these organisms to enter the human body is through the external acoustic canal, oral cavity, and pharynx and sino-nasal cavity. A study was conducted with clinical and mycological analysis of various fungal infections in ENT. Patients suspected for having fungal infections attending at Department of ENT were interrogated and analysed. Swabs collected from these cases were sent for direct microscopy by KOH mounts for fungal examination and fungal culture. Microbiological confirmed 100 cases were finally included in the study Histopathological examination of nasal mass and polyposis was also done. It was observed in this present study otomycosis was most common and accounted for 84% of the total cases followed by candidiasis in oral cavity and pharynx in 9%, allergic fungal rhinosinusitis in 4% and rhinosporidiosis in 3%. Aspergillus niger was that most common fungus isolated in 61% cases, followed by Candida albicans in 24% cases, Aspergillus flavus in 9% cases, Aspergillus fumigatus and Rhinosporodium seeberi in 3% cases each. All the cases of fungal infection of oral cavity and oropharynx were due to Candida albicans.
Ectoparasites on genitalia in this Era - a study at tertiary care center in T...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Rare Case of Nasal Inferior Meatus Polyps by George MV in Experiments in Rhinology & Otolaryngology
This is a case report of a patient with a sided nasal inferior meatus polyposis. A 34-year-old female patient rested with history of discharge coming from right side of nose of 6 months duration. On examination, there was minimal discharge in the floor of the nose. On endoscopy, there was a swelling under the inferior turbinate. CT PNS showed an enlarged inferior turbinate of the same side and bilateral concha bullosa, and mild maxillary sinusitis. The patient had undergone an endoscopic excision biopsy of the swelling and the histopathological report was Inflammatory Nasal polyps.
https://crimsonpublishers.com/ero/fulltext/ERO.000514.php
Tuberculosis: A Rare Cause of Linear Labial Ulcerationkomalicarol
Oral location of tuberculosis is rare. It admits a clinical polymorphism and poses above all a problem of diagnosis. We report a
case of labial tuberculosis in a 16-year-old patient with underlying
lymph node localization.
Abstract: We report a case of sinonasal paraganglioma presenting with episodes of epistaxis. A 55 year old male presented with a
nasal mass. It is an uncommon site of presentation and in an uncommon age group. A high grade of suspicion is required to diagnose
sino nasal paraganglioma. However, CT Scan and histopathology helps in early diagnosis and treatment. Surgical excision done with
cranialization of frontal sinus with fascia lata graft, followed up for 1 year without any evidence of disease recurrence.
Keywords: Sinonasal; Paraganglioma; Fascia Lata.
Microbial Flora in Chronic Rhinosinusitis with and without Nasalpolyps by José Gameirodos Santos in Experiments in Rhinology & Otolaryngology
The most common microbial agents in the etiology of chronic rhinosinusitis are defined in the literature as Staphylococcus aureus, Staphylococcus coagulase-negative and Streptococcus spp. In healthy individuals these same microorganisms are also the most frequent (mainly Staphylococcus coagulase negative) ascolonizing flora agents. We often encounter a poly microbial colonization of the nose and sinuses. The contribution of the different pathogens for the disease remains sun certain. The aim of this study is to compare the microbial flora found in patients with chronic rhinosinusitis with and without nasal polyps.
A 54 year old female, with history of uncontrolled Diabetes Mellitus presented with complaints of progressively severe frontal headaches with associated nausea and dizziness.
CT scan of the head revealed a 10 cm frontal bone lytic lesion extending into the nasal bones with evidence of sequestrum. Mucosal thickening and opacification of the frontal sphenoid and ethmoid sinuses was also noted. MRI was consistent with CT finding and revealed further cortical destruction of frontal calvarium outer table along with para-meningeal and dural enhancement. CSF studies were negative. Patient was started on intravenous antifungal therapy with Amphotericin B lipid complex. Frontal sinus trephination with irrigation/aspiration and simultaneous diagnostic nasal endoscopy revealed no frank pus or necrosis.
Aspirate’s bacterial and fungal culture were negative.
Patient underwent an open incision trephination of frontal sinus that revealed destruction/moth-eaten appearance of the anterior table of the frontal sinus, biopsies were taken, No pus was encountered.
Syringoma is a benign eccrine sweat gland tumor affecting mostly females at puberty projected with multiple soft papules usually 1-2 mm in diameter. During puberty, syringoma appears among females; it is presented as multiple soft papules, 1-2 mm in diameter, as a benign eccrine sweat gland tumor. The sites of predilection are lower eyelids, and cheeks. The regions of tendency are cheeks and lower eyelids. Syringoma of the vulvar is a rare disorder few cases of which have been reported in literature.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Available online at www.scigatejournals.com
SCIENTIFIC RESEARCH GATE
Middle East
Journal of
Case Reports
Middle East Journal of Case Reports 2016; 1: 1–3
http://scigatejournals.com/publications/index.php/mejcr
Page | 1
Rhinosporidiosis of Parotid Duct
A K M Maruf Raza1
*, Ajoy Bordhon2
, Popy Roy3
1. Assistant Professor, Department of Pathology, Jahurul Islam Medical College, Kishoregonj, Bangladesh.
2. Associate Professor, Department of otolaryngology, Jahurul Islam medical College, Kishoregonj, Bangladesh.
3. Assistant Professor, Department of Pharmacology, Jahurul Islam Medical College, Kishoregonj, Bangladesh.
Abstract
Rhinosporidiosis is a benign chronic granulomatous fungal infection caused by Rhinosporidium seeberi (R. seeberi), Rhinosporid-
ium kinealyi (R. kinealy). Rhinosporidiosis is endemic in South Asia, notably in Southern India and Sri Lanka.The common sites
of involvement are the nose and nasopharynx followed by ocular tissue. Rhinosporidiosis is also known to involve many rare sites
and may become disseminated to ocular in generalized form. Rhinosporidiosis of parotid duct is extremely rare. The case presented
here is of a 40 years old female from a village of Bajitpur, Kishoregonj with proliferative mass in the right parotid gland and parotid
duct. Surgical excision was done and the specimen was sent for histopathological examination. Although rhinosporidiosis was not
taken into consideration in the clinical differential diagnosis, eventual histopathological diagnosis confirmed rhinosporidiosis.
Key words: Parotid duct, Rhinosporidiosis, Histopathology, Granulomatous infection
Citation to This Article: Maruf Raza AKM, Bordhon A, Roy P. Rhinosporidiosis of Parotid Duct. Middle East Journal of Case Reports 2016; 1:
1–3.
1. Introduction
Rhinosporidiosis is a benign chronic granulomatous fungal disease caused by Rhinosporidium seeberi (R. seeberi) (1).
It occurs sporadically and is known to be noncontagious. Although human rhinosporidiosis occurs universally with
higher occurrence in parts of South Asia, it is endemic, especially in Southern India and Sri Lanka (2). The most
common site of infection in humans is the nose. Other sites include the nasopharynx, larynx, oropharynx, conjunctiva,
lacrimal sac, and genital mucosa. Intraorally, rhinosporidiosis is known to involve the lip, palate, and uvula, second-
arily, by direct extension from nasal and nasopharyngeal lesions1
. Primary involvement of the parotid duct is extremely
rare. We present a case of 40-year-old female from a village of Bhagalpur, Kishoregonj with proliferative mass in the
right parotid gland and parotid duct. Surgical excision was done and the presence of R. seeberi on histopathologic
analysis of the specimen was seen.
2. Case Report
A 40-year-old female reported to the department of otolaryngology with complaints of swelling on right side of the
face since 5 months, associated with a history of an increase in its size and also pain associated with swelling. No
other associated symptoms were reported. There was no history of trauma in the recent past. Patient had history of
consumption of unprocessed well water. On clinical examination, patient was moderately built with no signs of parlor,
jaundice, or lymphadenopathy. Systemic examination also did not reveal any abnormalities. The nose, nasopharynx,
oropharynx, and eyes appeared normal. On local examination, there was a single, soft to firm consistency, discrete
swelling on the right side of the cheek measuring about 4 × 3cm. Overlying skin was normal in color and texture with
* Corresponding author: Dr. A. K. M. Maruf Raza
Tel: +8801711306123
E-mail address: drmarufraza@gmail.com
2. Maruf Raza A.K.M. et al. Middle East Journal of Case Reports 2016; 1: 1–3
Page | 2
no local rise of temperature. There was tenderness felt on palpation with no fixity to underlying skin or structure.
Routine laboratory investigation revealed eosinophilia (eosinophils,15%). The fine needle aspiration cytology
(FNAC) showed presence of neutrophils and lymphocytes admixed with clusters and acini of ductal and myoepithelial
cells. Ultrasonography (USG) showed a solid and cystic lesion in the subcutaneous plane of cheek of size 3 × 1.6 cm,
with echogenic debris and internal septations. Surgical excision of the lesion was done under general anesthesia. The
lesion was identified as dilated segment of the parotid itself. The proximal and distal parts of the ducts were dissected
further and were found to be in continuity with the mass itself. The excised specimen was submitted for histopatho-
logic examination. The hematoxylin-eosin stained sections showed thin fibrocollagenous cystic wall lined by colum-
nar to cuboidal to flattened cells. One of the parts of the specimen showed the presence of numerous, sporangia of R.
seeberi (Figure 1 and 2). Histopathological examination confirmed the diagnosis of rhinosporidiosis of the parotid
gland duct.
3. Discussion
The pathogen R. seeberi was first discovered by Malbran in 1892 and later, cases in cattle were reported in India in
1894 (3). It was first described by Seeber (4) in 1900 in the nasal region in his doctoral thesis of medicine. Review of
the literature shows frequency of the disease to be greater in South Asia, with the largest number of cases having been
reported in Southern India and Sri Lanka (2). Men are affected more than women (male: female ratio, 4: 1). Patients
of all ages are affected, but the disease most frequently occurs in those aged between 20 and 35 years. Common sites
of involvement include the nose and upper respiratory tract (1). In our case the parotid was considered to be the
primary site of inoculation of the organism because there were no other nasal or nasopharyngeal lesions. The diagnosis
of rhinosporidiosis is primarily made by observing the distinctive morphologic features of R. seeberi in affected tissue.
Its life cycle begins in the tissue as a spore, and it passes through several stages of development from trophocyte to
juvenile sporangium to mature forms with changes in thickness and lamination of walls. Nuclear condensation takes
place to form endospores embedded in a mucoid matrix. Characteristically, special electron dense bodies of about 1
to 3mm are seen in mature endospores. These endospores become extruded into the surrounding thick sporangial wall
and eventually develop into trophocytes to perpetuate their life cycle (5).
The most common mode of spread to host is by transepithelial infection or by autoinoculation. Infection with R.
seeberi is most likely waterborne. A high incidence has been observed in patients who dive and swim in stagnant
water (6). Individuals probably acquire the disease from water contaminated by diseased cattle. As our case patient
had history of consumption of unprocessed well water. Because the organism has not been isolated in culture, the
histopathologic examination remains the gold standard for diagnosis (7). The larger and thick walled sporangia of R.
seeberi differentiate this lesion distinctly from the organism causing coccidioidomycosis (8). The only drug which has
been shown to have some rhinosporicidal effect is Dapsone, which arrests the maturation of sporangia and promotes
fibrosis in the stroma, when used as an adjunct to surgery (6). Treatment of choice is surgical resection (1), as most
recurrences occur due to spillage of endospores on adjacent mucosa.
4. Conclusion
Rhinosporidiosis is a benign chronic granulomatous fungal disease caused by Rhinosporidium seeberi (R. seeberi).
The most common site of infection in humans is the nose. Other sites include the nasopharynx, larynx, oropharynx,
conjunctiva, lacrimal sac, and genital mucosa. Primary involvement of the parotid duct is extremely rare. We present
a case of 40-year-old female from a village of Bhagalpur, Kishoregonj with proliferative mass in the right parotid
gland and parotid duct. The purpose of this report is to encourage clinicians to be flexible in the differential diagnosis
of proliferative growth in the parotid duct, even in those from nonendemic areas.
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